1. Z-PLASTY: GENERAL SURGICAL
PROSPECTIVE
By- Dr.Kundan Kharde
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2. Conventional technique
1. Post Burn Scars- are managed by release /
excision of scar followed by SSG, and post
operatively patient requires splinting in
corrected position for almost 6-12 months
to prevent recurrence of deformity. But
compliance of patients for prolonged
splinting is very poor, hence come back
with recurrence.
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3. Conventional technique
Pilonidal sinus : Several surgical techniques
are available for repair of the defect created
after excision of pilonidal sinus including
excision and direct closure, marsupalisation,
skin grafting or local flaps but each
technique has some advantages/ limitations.
Recurrence is almost 40% percent after
excision and direct closure.
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4. Z- PLASTY-is it the answer?
1. Scars- Z-plasty serves to reorient and lengthen
a scar
2. In Pilonidal disease- Z-plasty eliminates the
deep natal cleft by bringing healthy, lateral skin
and subcutaneous tissue into the midline
3. This report is based on our experience in
managing 10 cases of Post burn contractures and
05 cases of Pilonidal sinus utilising Z-plasty
technique.
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5. What is Z-plasty?
Z-Plasty is a surgical technique that is
extensively used in plastic surgery to
lengthen the linear scars and thus correct the
deformity and improve the function.
This technique redirects the forces acting
on the scar to improve the appearance.
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6. Z- plasty in Scar contracture
A total of 10 patients of scar contractures
were operated.(linear scars)
There were 5 males and 5 females, in the
age group of 3 – 30 years.
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7. Z-plasty in Scar contractures(cont)
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8. Z-plasty in Scar contractures(cont)
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9. Z-plasty in Scar contractures(cont)
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10. Z-plasty in Scar contractures(cont)
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11. Z-plasty in Scar contractures(cont)
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12. Z-plasty in Scar contractures(cont)
Result
Complications Number of patients Percentage
Flap necrosis 0 0%
Wound infection 2 20%
Hematoma formation 0 0%
Dehiscence 0 0%
Trap door effect 0 0%
total 2 20%
Scar lengthening was achieved in all the cases and
02 cases had superficial wound infection, which
resolved by dressings
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13. Z- plasty in Pilonidal sinus
A total of five patients of Pilonidal sinus
were operated
All were males, majority in the age group of
15 – 30
The operating time ranged between 30-45
minutes (mean 35 + 2).
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14. Z-plasty in Pilonidal sinus (cont.)
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15. Z-plasty in Pilonidal sinus (cont.)
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16. Z-plasty in Pilonidal sinus (cont.)
Result
Complications Number of patients Percentage
Flap necrosis 0 0%
Wound infection 1 20%
Hematoma formation 0 0%
Dehiscence 0 0%
Trap door effect 0 0%
total 1 20%
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17. Z-plasty in Pilonidal sinus (cont.)
Mean postoperative stay was 3.5 days ( 2-5
days) and return to work was between 7 –
18 days (Mean 12.5 days).
There was no recurrence
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18. What Z-plasty achieves ?
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19. Changing the direction favorable scar
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20. Basic Z-Plasty
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21. Technique
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22. Geometric scale
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23. Complication
1. Hematoma formation
2. Wound infection
3. Dehiscence
4. Trapdoor
5. Flap necrosis
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24. Discussion
Multiple reconstructive methods have been used
for the treatment of postburn scar contractures
including skin grafting, local flaps and free flaps.
Similarly, multiple Techniques such as drainage,
excision, and marsupilization yield mixed results
in the treatment of pilonidal sinuses. Patients are
often dissatisfied, because of long post op period
and recurrence.
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25. Discussion (cont.)
Severe contracture lines crossing flexion folds can
be released effectively by using Z- plasty
technique.
In pilonidal disease, the Z- plasty eliminates the
deep natal cleft by bringing healthy, lateral skin
and subcutaneous tissue into the midline.
Excision and Z- plasty together can lead to a low
recurrence rate with rapid healing
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26. Conclusion
In linear scar contracture Z plasty technique
helped to increase the length of scars with
release of contractures
In pilonidal sinus management with Z
plasty showed zero recurrence and less
hospital stay
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27. Conclusion
Z- plasty is a versatile technique, easy to perform
and can be an armamentarium of general surgeon
to manage linear scar contractures where scar
lengthening is necessary.
Once the concept of dual transposition of the
triangular flaps is understood, any general surgeon
should be able to use to achieve optimal results
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28. References
1. Wiliams NS, Christopher JK. Bulstrode P,Ronan O Connell. Pilonidal
sinus. In: Bailey and Love’s Short practice of
Surgery.25thed.London: Hodder Arnold 2008:1247-8.
2. I. Iesalnieks, A. Furst, M. Rentsch and K.W. Jauch. Primary midline
closure after excision of a pilonidal sinus is associated with a high
recurrence rate.Chirurg, 74 (2003), pp. 461–468
3. The basic Z-plasty. Am Fam Physician. 2003 Jun 1 ;67(11):2329-32
4. Bernstein L. Z-plasty in head and neck surgery. Arch Otolaryn
89:574-84, 1969 Apr
5. Rohrich RJ, Zbar RI. A simplified algorithm for the use of Z-plasty.
Plast Reconstr Surg 1999;103:1513-7.
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